Better care, more locally, within budget, through transformation

Welcome to our Annual General Meeting

Better care, more locally, within budget, through transformation

AgendaChairman’s Welcome and Introduction to the

Annual General Meeting (AGM)Dr Gina Palumbo, Clinical Commissioning Group Chair

Review of the Year 2013/14Jane Hawkard, Chief Officer

Annual Accounts 2013/14Richard Dodson, Chief Finance Officer

Questions and Answers

Better care, more locally, within budget, through transformation

Introduction

Dr Gina PalumboClinical Commissioning Group Chair

Better care, more locally, within budget, through transformation

Basic Facts1000 square miles340,000 approximate population37 GP Practices43 Dental Practices 60 Pharmacies 65 Optometry Practices3 Prisons4 Community Hospital Sites 9 Health Centres/Clinics 1 GP Access Centre3 Acute Hospitals2 District Hospitals

No A&E in the County

Better care, more locally, within budget, through transformation

Our Population’s HealthLife ExpectancyLife expectancy for men is higher than England averageButThere is a difference in life expectancy between those in the most deprived and those in the least deprived

Obesity is a problem19% of Year 6 Children are classified as obeseLevels of adult obesity is higher than England average

DeprivationLower than averageButThis masks the fact that some areas are very deprived

Early death rates have fallenEarly death rates for cancer, heart disease and stroke are better than England average

Better care, more locally, within budget, through transformation

Our Populations Health – Our PrioritiesAddressing the health needs of the ageing population

(Quality of Life)· Opportunities through transformation of the service model to support the management of Long Term Conditions

and promote self care

Addressing inequalities in health outcomes (Quantity of Life)

· Opportunities through preventing ill health development and minimising deterioration of existing conditions

ERY Clinical Commissioning Group Operational & Strategic Plan 2014-2019

Addressing the mental and physical health and wellbeing ofChildren and Young People

National Priorities•Reduce infection from MRSA and C.difficile•Reduce hospital mortality

Budget Management•Meet statutory duty to balance budgets

Better care, more locally, within budget, through transformation

Your Local Clinical Commissioning Group

Local GPs have been through a nomination and election process for the East Riding CCG and non-GP members have also been identified. Membership is as follows:GP Members• Beverley and Driffield

Dr Gina Palumbo (CCG Chair)Dr Richard Little

• Goole, Howdenshire and West Wolds • Dr Clive Henderson

Dr Frank Thornton• Haltemprice

Dr Krishnaraj Sivarajan• Bridlington

Dr Alan Francis•  Holderness

Dr David Fitzsimons

Other members • Secondary Care Doctor• 3 lay members:

– Vice Chair – Patient & Public Participation– Audit & Governance

• 1 Local Authority representative• 3 Executive Directors:

• Chief Officer• Chief Finance Officer• Director of Quality & Governance /

Executive Nurse• Director of Public Health (ERYC)• ERY Healthwatch representative

Better care, more locally, within budget, through transformation

A New Role for Clinicians• To buy and ensure delivery of

services appropriate to meet reasonable local needs.

• Work with all involved to drive out waste and maintain quality

• To ensure sustainable, high quality, safe and effective services and good patient experience

Better care, more locally, within budget, through transformation

Strong Locality Working

Better care, more locally, within budget, through transformation

Pressures on the NHS• Demographics• The incremental nature of health

care• The technological and therapeutic

advances• The increased complexity and

fragmentation• The expectations• The fiscal challenge• NHS has been relatively protected

Better care, more locally, within budget, through transformation

So where will the resources for health

and social care come from?

Better care, more locally, within budget, through transformation

Scaling up of Small ChangesWe all have to do something different

to achieve our aim of…

…better care …closer to home …within budget

Through TransformationGPsPatients

Local Authority

Hospitals CommunitiesVoluntary

SectorPrivate Sector

Policy Makers

NursesAllied Health

Professionals

Better care, more locally, within budget, through transformation

What clinicians could do differently

• Lead on changing clinical behaviour• Lead on collaboration and integration• Reduce variability of health care• Secondary care moving out into community• Centralisation of specialist

services• Working with Local Authority

and Public Health – Health and Well Being Board

Better care, more locally, within budget, through transformation

What can patients and doctors do differently together?

Aim of the Health and Social Care Act – Patients central,

informed and empowered to

co-produce solutions

Better care, more locally, within budget, through transformation

“Doctor, what can I do to improve my own health and

well being?”

Better care, more locally, within budget, through transformation

A different conversation• Understand and own our own

contribution to our (ill) health• Take responsibility for sharing in

decisions• Agree our plan and help to monitor

outcomes• Be our own expert• Be our own (biggest) change agent• Share our experience and inspire

someone else

Better care, more locally, within budget, through transformation

Keep it simple and straight forward

• No smoking• Moderate alcohol consumption• Regular exercise• 7-8hrs sleep• Regular meals with no snacking• Maintenance of moderate body

weight• Regular consumption of breakfast

1965 Lester Breslow’s benefits of seven healthy habits

Better care, more locally, within budget, through transformation

Long Term Conditions – The Facts

• Account for £7.00 out of every £10.00 spent in the NHS• In the East Riding…

• 50% of all GP appointments… • 65% of all outpatient appointments and • 72% of all patient stays on hospital wards• are taken by people with long term conditions

• But we have a pill for everything, Don’t we?

Better care, more locally, within budget, through transformation

The Burden of Treatment

Better care, more locally, within budget, through transformation

What can the Health and Social Care

Community do differently?

Better care, more locally, within budget, through transformation

Be honest, open and transparent

• One voice, one message across Health and Social Care

• With political support – H&WB• Doctors to maintain trust• Publish as much as we possibly

can• Be accessible and open to

challenge

Better care, more locally, within budget, through transformation

Better care, more locally, within budget, through transformation

It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

The NHS belongs to the people

Better care, more locally, within budget, through transformation

2b. Patients and the public – your responsibilities

The NHS belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly…

Better care, more locally, within budget, through transformation

You should…

recognise that you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it.

register with a GP practice – the main point of access to NHS care.

treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution.

provide accurate information

Better care, more locally, within budget, through transformation

keep appointments, or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.

follow the course of treatment which you have agreed, and talk to your clinician if you find this difficult.

participate in important public health programmes such as vaccination.

ensure that those closest to you are aware of your wishes about organ donation.

give feedback – both positive and negative – about the treatment and care you have received, including any adverse reactions you may have had.

Better care, more locally, within budget, through transformation

Hard Truths and our Duty of Candour

• Scandals of Mid Staffordshire Hospital and Winterbourne• Our collective future needs us all to face some hard

truths about how we are all responsible for improving quality through being open and honest with patients / the public and across organisations

• CCG Public Pledges in line with Hard Truths – to ensure focus is maintained on improving quality

Better care, more locally, within budget, through transformation

Review of the Year 2013/14

Jane Hawkard, Chief Officer

Better care, more locally, within budget, through transformation

East Riding of Yorkshire Clinical Commissioning

GroupPlanning to do something different

2014/15 to 2018/19

Better care, more locally, within budget, through transformation

Improve services for older

people

Improve planned

care services

Partnership working

with local authority

Improve emergency

care services

Better management of people with long term conditions to reduce avoidable admissions.

Increase access to early diagnosis and treatment for

patients with dementia.

Increase number of patients able to die in their place of choice.

Increase patient involvement in decision making about the

right care for them through:

•Improved patient information.

• Roll out of Map of Medicine software use in GP surgeries.

Review access to locally based musculoskeletal services

Reduce number of patients admitted with a hip fracture by

5% from 2012/13 levels.

Improve patient experience of A&E services.

Increase accessibility to minor injury services

Improve patient experience of our Child and Adolescent

Mental Health Services (CAMHS).

Improve access to more local, primary care based

psychological therapies.

Increase the number of assessments for autism and

access to programmes.

CCG PLAN 2013 -14

Better care, more locally, within budget, through transformation

Supporting People with Long Term Conditions model– Long term condition clinics in primary care, 28 of

our 38 practices, covering 86% of our population

Dementia Services– Increased Memory Clinic capacity– Increased diagnosis rates from 37% to 41% in last

few months of the year– Commissioning a Mild Cognitive Impairment

service– We still need more capacity for diagnosis and

treatment

Access to Psychological Therapies for Anxiety and Depression

– Increased the number of service Providers from 2 to 8

– Mobilisation of service between April and September 2014

– We need to see the new service working at full strength

Timely access to good quality psychological therapies’ with a focus on recovery.

Early diagnosis, good information, supporting individuals to live well with their dementia diagnosis.

Empowered patients, personalised care

What we have achievedand still more to do…

Better care, more locally, within budget, through transformation

Children and Adolescent Mental Health Services• reduce waiting times• increased out of hours access to service • further waiting time reductions to achieve

Falls service• new specialist service, reducing emergency

admissions for hip fractures by 25%

Quality of Services• Reduced number of Hospital Acquired Infections• Reduced hospital mortality rates to within expected

range in our local hospitals • Launched patient engagement initiative ‘involve’ • Reduced deaths in hospital by 37% by increasing

choice for patients on end of life pathways

What we have achievedand still more to do…

Help with preventing falls

Better care, more locally, within budget, through transformation

Patient Network

involve

www.eastridingofyorkshireccg.nhs.uk/involve

Want to help improve NHS services across East Yorkshire?

Join involve!

Better care, more locally, within budget, through transformation

Challenges and what has not gone so well…

• Some national targets not met – waiting times (A&E, 52 week waits, access to psychological therapies)

• ‘involve’ patient network – slower start than we would have liked

• The pace of change

• Challenges for Primary Care Workforce

• Care Quality Commission recommendations for the East Riding Community Hospital and Hull Hospitals Trust

Better care, more locally, within budget, through transformation

1. Improving Primary and Community Services2. Transforming the Urgent Care system3. Planning care efficiently4. Integrating services5. Improving services for vulnerable people

Better care, more locally, within budget, through transformation

Looking Forward to years 2 and 3Making a difference and improving outcomes for patients

Safe, High Quality, Sustainable, Productive Care

Unplanned Care Services

DeliveringCommunity urgent response teams

OutcomeReducing avoidable emergency admissions

SYSTEM VISION STATEMENTS

• Individuals take greater ownership of their own health and wellbeing• Services are, in the main, delivered in the community by a range of providers• Integrated health and social care through locality focused service delivery hubs • The remit for hospital based services is clear and reflects where they can add

value and expertiseProductive

Elective Care

Delivering Consistent and systematic services

OutcomeTransforming follow up appointment systems

Integration of services to

provide ‘Better Care’

DeliveringMore joined up health & social care services

OutcomeIncreasing people (65+) discharged home from hospital rather than into a care home.

Community Services

and Primary Care

DeliveringLocality hubs for health & social care services

OutcomeImproving quality of life for people with long term conditions and complex needs

Supporting Our Vulnerable People

Delivering Better Dementia and for Children and Adolescents Mental Health Services

OutcomeIncrease the levels of diagnosis of dementia and treatment services

Better care, more locally, within budget, through transformation

3. Rehab & Reablement

Locality

HubCommunication Communication

Testing Our Pilot Locality Hub Model1. Focus on self care

and independent living

2. Locally delivered services where possible

3. Joined up health and social care

4. Hospital based services available when needed

Better care, more locally, within budget, through transformation

Annual Accounts 2013/14

Richard Dodson Chief Finance Officer

Better care, more locally, within budget, through transformation

Secondary Care

Mental Health Continuing Healthcare

Prescribing

Community

Primary Care

Running costs

Other

Better care, more locally, within budget, through transformation

Financial Duties

Manage within Budget

Manage within Cash Limit

Manage within Capital Limits

Manage within Running Costs Target

Better care, more locally, within budget, through transformation

An unqualified opinion was issued. Financial statements give a true and fair view In all material respects, the expenditure and income

have been applied to the purposes intended by Parliament

Have been properly prepared in accordance with the accounting policies directed by the Secretary of State

Proper arrangements for securing economy, efficiency & effectiveness

2013/14 Accounts

Better care, more locally, within budget, through transformation

Full Set of Accounts

A full set of Accounts for 2013/2014 is available within the Annual Report here at the AGM, or on the

CCG Internet http://www.eastridingofyorkshireccg.nhs.uk

or by contacting us on 01482 672156